Nutrition and Breastfeeding Conference Registration

Nutrition and Breastfeeding Conference Registration
Electronic Version of Form: http://www.okwic.com
Original Form Last Updated On: 01/30/2012
For questions, please contact the OUCPM Helpdesk at (405) 325-6257. Page 1
WIC Registration
To register for May 29 and/or May 30, please complete the following form and click REGISTER when finished. Fields marked with * are required.
First Name *
Last Name *
Email Address *
Phone *
Which of the following best describes you? *
Independent WIC Staff OSDH WIC Staff Tribal WIC Staff
Special Accommodations:
Nutrition Conference
Which session will you attend on Wednesday, May 29 (for WIC staff only)? *
I will not attend this day
I will attend the Nutrition Sessions
I will attend the Administrative Support and Management Sessions
Which session will you attend on Thursday, May 30 (for WIC staff only)? *
I will not attend this day
I will attend the Nutrition Sessions
I will attend the Administrative Support and Management Sessions
Breastfeeding Conference
Will you attend the Friday, May 31 session (for healthcare professionals only)? *
I will not attend this day
I will attend this day
Laura K Savage Poster Contest
I wish to participate in the Laura K Savage Poster Contest
Nutrition and Breastfeeding Conference Registration
Electronic Version of Form: http://www.okwic.com
Original Form Last Updated On: 01/30/2012
For questions, please contact the OUCPM Helpdesk at (405) 325-6257. Page 2
Non-WIC Registration
To register for May 31, please complete the following form and click REGISTER when finished. Fields marked with * are required.
First Name *
Last Name *
Email Address *
Phone *
Special Accommodations:

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Nutrition and Breastfeeding Conference Registration
Electronic Version of Form: http://www.okwic.com
Original Form Last Updated On: 01/30/2012
For questions, please contact the OUCPM Helpdesk at (405) 325-6257. Page 1
WIC Registration
To register for May 29 and/or May 30, please complete the following form and click REGISTER when finished. Fields marked with * are required.
First Name *
Last Name *
Email Address *
Phone *
Which of the following best describes you? *
Independent WIC Staff OSDH WIC Staff Tribal WIC Staff
Special Accommodations:
Nutrition Conference
Which session will you attend on Wednesday, May 29 (for WIC staff only)? *
I will not attend this day
I will attend the Nutrition Sessions
I will attend the Administrative Support and Management Sessions
Which session will you attend on Thursday, May 30 (for WIC staff only)? *
I will not attend this day
I will attend the Nutrition Sessions
I will attend the Administrative Support and Management Sessions
Breastfeeding Conference
Will you attend the Friday, May 31 session (for healthcare professionals only)? *
I will not attend this day
I will attend this day
Laura K Savage Poster Contest
I wish to participate in the Laura K Savage Poster Contest
Nutrition and Breastfeeding Conference Registration
Electronic Version of Form: http://www.okwic.com
Original Form Last Updated On: 01/30/2012
For questions, please contact the OUCPM Helpdesk at (405) 325-6257. Page 2
Non-WIC Registration
To register for May 31, please complete the following form and click REGISTER when finished. Fields marked with * are required.
First Name *
Last Name *
Email Address *
Phone *
Special Accommodations: